EMDR - Great therapy, shame about the name
When I first trained as an EMDR therapist it took me at least 6 months to be able to say the name without getting stuck. Just imagine saying: Eye Movement Desensitisation and Reprocessing. It is a mouthful. And yet, behind the long and slightly unfortunate name - even by EMDR founder's Francine Shapiro's admission - lies a very powerful psychotherapy. In fact, EMDR's effectiveness has gained worldwide recognition, both from the World Health Organisation and the NHS and the NICE guidelines, as the recommended treatment for post traumatic stress disorder (PTSD).
What is EMDR all about?
In the words of Francine Shapiro, it is about 'getting past your past'. Most people do not necessarily like dwelling on the past, especially the negative aspects. In fact, I would argue that in therapy the past is only as relevant as its power to affect us now.
Example: Let's say I grew up in a family where there were arguments. Lots of them. Sometimes fuelled by alcohol. Always ending in big fall outs and sometimes in violence. It scared me as a child. Fast forward to my adult life. I'm doing ok really, have a family and a stable job. But when I hear raised voices, my body reacts really strongly and I can't help it. My tummy goes into a spasm, I have this horrible sinking feeling, I panic. I feel scared, even though I'm a grown up and the raised voices can be nothing to do with me. I feel scared of conflict, any potential conflict, I avoid it as much as I can. As a result, I tend to go along with what others want, even if I disagree. That's how I said 'yes' to the overtime at work, even though it means I get home really late. And my bedroom is dark blue - I hate the colour, but it was not worth an argument with my partner…
The past, even when we try not to dwell on it, can sometimes hold us back in our present life. EMDR has helped many people to be freed from the negative aspects of the past so that they can go about their lives without being held back. Worldwide it is a recommended treatment for PTSD, where people develop a severe reaction after a life-threatening event. PTSD is typically associated with war veterans but can, in fact, affect anybody. The symptoms can include:
- re-living the trauma (flashbacks)
- trying to avoid anything connected to the traumatic event
- extreme body reactions when we come into contact with a reminder of the trauma
- constant agitation and 'scanning' the environment for any sign of a trauma reminder.
Very difficult for one to live with and function...and also difficult for family and friends, as relationships can be affected.
The 'Big' and 'Small' traumas of life
However, it is not just life-threatening events that can feel traumatic. Francine Shapiro talked about the 'Big T' and 'Small T' traumas. A tsunami or a car crash could be examples of 'Big T' traumas. On the other hand, losing control of your bladder aged 5 in front of the whole class and being laughed at would also be extremely upsetting, . That child, as an adult, can feel very ill-at-ease whenever there is any attention directed at him (parties, public speaking, interviews etc) and perform poorly as a result.
Conditions EMDR has successfully been used for
EMDR is a psychotherapy that aims to help you put the hurtful, tragic, humiliating, painful or frightening experiences behind you if you feel they are still affecting you now. As well as PTSD, it has been used successfully to treat a variety of problems where negative life experiences seem to be at the root of such diagnoses as:
- anxiety and worry
- low mood and depression
- relationship difficulties
- low self-esteem
- eating disorders
- complex grief
- chronic pain
- childhood sexual abuse...to name a few
How do I know it may help me?
How can you know if you are still affected by the negative experiences from your past? As a rule of thumb, if you notice that you repeatedly react out of proportion in certain situations, it is a good indicator of issues needing attention. Similarly, if people who you know have your best interest at heart suggest you seem to over-react or see things in extreme ways, their concern would also be worth bearing in mind.
So how does EMDR work?
You know what EMDR might be helpful for, but how exactly does it work? Well, in order to answer the question, we need to talk about our amazing brain first. In simple terms, our logical, rational, time-and-space-anchored and verbal self-occupies the left hemisphere. The right hemisphere is where emotions and raw sensations 'live'. Our wonderful brain works really hard to analyse and process our ongoing experiences so that we can make sense of the world and keep on going as safely as possible. In the process the left and right hemisphere 'talk to each other', laying down neural pathways. This process is called Adaptive Information Processing.
Adaptive Information Processing - when it works well
Our brain helps us process what is happening to us all the time, the majority of the time it does this really successfully and efficiently. Sometimes, it helps us get over intensely emotional experiences so that we can learn from them.
Let's look at an example. Imagine you have had a bad argument with your partner. On the day of the argument, your emotions would probably be riding high. But give it a day or two, maybe a bit longer and you would have 'slept on it'; perhaps you would have talked it over with a friend (who might introduce a different perspective on the issue). You might be able to see that some of the things that had been said - also by you - were a bit unfair. So you learn from the experience, all courtesy of your fantastic brain. Maybe you and your partner talk again and you come to a different, hopefully, better understanding. Given enough time for your brain to process the original argument, the memory of it will no longer produce a strong emotional reaction. You may even be able to laugh about it, with all the negative feelings gone but useful lessons learnt.
Your brain has just done a brilliant job of processing the argument - that is, letting go of what is not useful (the emotional charge) and retaining what is helpful (the memory of the argument and lessons learnt). Here we have a very good example of our left (logical, rational) and our right (emotional) part of the brain working together well and adaptive information processing happening smoothly.
When Adaptive Information Processing gets 'stuck'
However, sometimes we experience events so painful, traumatic or terrifying that we find it difficult to 'get over' them. I am sure that you can think of something in your own life that you still get quite emotionally stirred by when you are reminded of it or come into contact with.
For me, ever since I was a little girl, it was a fear of dogs. Any dogs, whether they were big or small, friendly or not. My radar was out at all times scanning for the terrifying (to me) creatures. I would regularly cross the road not to have to pass a dog, even one accompanied by its owner and on a leash. My body would experience a terrifying adrenaline rush every time I saw a dog or; worse still if I heard it bark or growl, especially unexpectedly. I really felt that the little chihuahua I had just passed was going to break the leash, jump at my throat and kill me this instant. How ridiculous, I ask you.
Now, my logical and adult self-knew very well that it was completely irrational. Dogs are (most of the time) friendly creatures who, if treated with respect and kindness, reciprocate in kind. It is for a good reason that they are thought of as 'man's best friend'. So I really felt rather silly not being able to control my feelings and my body's reaction.
This example illustrates quite clearly that my poor brain couldn't quite help me in the way it normally does. I did have a bad experience with a dog when I was little; the terror of it lived quite happily unprocessed and in its raw form in my right hemisphere, hijacking my emotional and physical responses every time I came into contact with a dog. My left hemisphere, with all my intelligence, ability to reason, extensive vocabulary and a sense of time and space, seemed to have gone on vacation. It had no influence over my reactions. This is an example of the adaptive information processing getting 'stuck'. The two hemispheres just weren't talking.
How EMDR 'kick-starts' the healthy process of Adaptive Information Processing
In the course of EMDR therapy, metaphorically speaking, the left and right hemisphere are enabled to 'talk' and new neural pathways are formed. The 'grown-up' and 'rational' left hemisphere helps the 'traumatised' right hemisphere notice that the danger (or trauma or hurt etc) is in fact over. Processing of information that had got 'stuck' is resumed and we emerge with a new, more adaptive understanding of the world and ourselves in it. This is called reprocessing.
Talk me through what I can expect during EMDR therapy
After a period of thorough assessment, history taking and preparation, together with your therapist you will identify distressing memories and reprocess them (which helps the brain 'digest' the memory - a bit like our example of an argument with your partner). Once successfully reprocessed, when the memory is activated, it no longer produces an out-of-proportion emotional response. In other words, you would have become desensitized to the memory and it is no longer distressing. On top of it, you would have also developed a new and better understanding of the experience and yourself in it.
You will be pleased to know that there are no electrodes involved in helping the brain to reprocess what had got stuck. Rather, the two hemispheres are stimulated by a variety of simple methods. These include eye movement (hence the name), tapping on hands or knees, using hand-held pulsars and sound (through headphones). You will decide what works best for you.
EMDR can produce quite rapid results, with many clients reporting having resolved an issue they struggled with for a long time within a few reprocessing sessions. At the same time, it is not a shortcut or just a technique. As always, all the good principles of ethical psychotherapy apply. Your therapist will take time to get to know you, and help you gather important information about yourself and events in your life that have helped to shape you. This will aid your shared understanding of how things came about. Your therapist will attend to your safety and make sure that you create ways of managing strong emotions well and that EMDR is used at the right time for you. She or he will attend to ways you normally cope with difficult feelings and, if these tend to be self-destructive, you will work on this together first and learn new, more helpful ways. All of this will take time and it varies from person to person. There may be times when EMDR would not be recommended (for example if you have very little stability in your life or when you are in the middle of a crisis).
Phases of EMDR
1. History taking
This is very important as you and your therapist need to create a good shared understanding of what your life experience has been until now. Together, you will explore your formative relationships and life events, what you think and believe about yourself, how you manage strong emotions and what current support you have.
Your therapist will help you learn techniques to manage strong emotions with greater ease. This is in itself a fantastic tool and there are clients for whom this is the most useful skill to implement in their lives. Additionally, it really helps with managing strong emotions in phase 4 (reprocessing). Preparation phase varies in length from person to person.
Together with your therapist you will decide which events, feelings, beliefs about yourself or physical sensations cause you the most distress. These will be your 'targets' to reprocess next so that you no longer find them as upsetting.
4. Desensitisation or reprocessing
Successful desensitisation makes it possible for you to no longer be distressed by what you find really upsetting now. Additionally, a new and more helpful understanding of the situation and yourself emerges so that you can learn from past experiences while not being affected emotionally anymore.
In this phase, being guided by your therapist, you bring your target memory (if you have one) or a sensation, or a feeling, or perhaps a negative belief to mind, while experiencing bilateral (which means two sides) stimulation. This could take the form of following the therapist's finger with your eyes (left to right or diagonal), or holding alternating pulsars in your hands, or listening to alternating sounds through the headphones or having your knees or back of your hands gently tapped. Your therapist will try different ways of bilateral stimulation with you to find one that you prefer.
This phase can feel like a bit like a game of word association (you know - the one where somebody says a word and you come up with the first thing that comes into your mind), only this time it is your brain silently coming up with important links, memories, sensations, feelings and beliefs. All this while you receive the bilateral stimulation. In order to interfere as little as possible with the workings of your brain, there is usually little, if any, talking involved in any one 'set' of bilateral stimulation. Your therapist will have skilful ways of helping you along the process.
Ever so often, when you and your therapist feel is a good time to pause - you do. In this time you usually check in and briefly signal what has come up for you in a set (although how much you share is up to you and can be minimal). Your therapist will encourage you to 'go with' whatever has come up for you, trying not to judge the process.
The lovely thing about EMDR is that you cannot 'fail' at it and whatever your brain comes up with is for a good reason. Sometimes it may be something that makes sense to you straight away. And sometimes it is something that surprises you (like a memory you had half-forgotten) or something that puzzles you, where you cannot see a connection or significance of what's come up straight away. Fear not, it will become apparent so just try and trust the process. Your therapist will have skilful ways of facilitating the process.
Once the memory is no longer distressing, your therapist will enable the new, more helpful and more adaptive understanding be reinforced with further bilateral stimulation so that it really takes hold in your brain.
6. Body Scan
Your therapist will guide you through a body scan to see if there are any residual negative sensations to pay attention to. If there are any, these to will be reprocessed with additional bilateral stimulation.
Your therapist will debrief with you after reprocessing, ask about your experience of it, insights gained, tell you what to expect after the session and how to look after yourself between sessions. If appropriate, you may be guided through a self-calming exercise.
After reprocessing, together with your therapist you will talk about whether all the necessary targets have been processed to allow you to feel at peace with the past, empowered in the present and able to make good choices for the future. Targets involve past events, present difficulties and future challenges.
EMDR-therapist perspective and client feedback.
EMDR can work particularly well for people who find it difficult to translate what they know rationally into what they feel deep down. In my experience, EMDR comes into its own when talking alone, reasoning things out and even changing your behaviour (all of which make a huge positive difference to many people) make limited impact on how you feel deep down.
What happens in reprocessing is that the old traumas lose their emotional potency and a new understanding of the event and yourself emerges. This new insight can feel very profound and helpful. Because it is the client who arrived at the new perspective, they feel the insights 'really belong to them'. The new understanding feels an integral part of the client from then on. So it is no longer a conscious struggle to retain the new perspective; rather, clients may find their new understanding to be natural and effortless, a kind of new 'automatic' setting.
- "Getting Past your Past", Francine Shapiro, Rodale Incorporated, 2013
- "EMDR Solutions II", Robin Shapiro ed., Norton and Company, 2009
- "Integrating EMDR into Your Practice", Liz Royle and Catherine Kerr, Springer Publishing Company, 2010
- "A Therapist Guide to EMDR", Laurel Parnell, Norton and Company, 2007
- "Attachment Focussed EMDR", Laurel Parnell, Norton and Company, 2013